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Chronic pancreatitis
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
The main complications in early series were mainly bleeding, as well as infection and retroperitoneal perforation, occurring in about 10–15% of patients [2–4]. Few series detail long-term follow-up, but probably about one-third of cases will have a cyst recurrence. In one series [4], despite a good initial 90% success in endoscopic drainage, 10 of 37 patients needed surgery for recurrent disease within a mean 32-month follow-up period. Pre-procedure CT scanning will show if the cyst is closely approximated to the gastric or duodenal wall, and show whether there are any variceal collaterals between the stomach and cyst wall. Unfortunately, it is common to find quite a thickening and gap between the stomach and cyst due to retroperitoneal inflammation even though the cyst produces an endoscopically visible bulge. If the cyst is more than 5–6 mm away from the gastric lumen, endoscopic puncture and drainage can fail. Commonly in chronic pancreatitis – but less so in cysts associated with acute disease – there will be portal vein compression or thrombosis, with portal collaterals coursing along the gastric wall; this represents a significant hazard to endoscopic therapy. These vessels are not visible from the lumen endoscopically, and the use of endoscopic ultrasound will determine both the distance between the gastric lumen and cyst and the presence of any significant blood vessels beneath the area of intended puncture in some detail. A conventional ultrasound endoscope cannot be used for therapy, and a suitable puncture site would have to be marked by clipping or dye injections submucosally before performing a procedure with an end-viewing or side-viewing instrument. The use of endoscopic ultrasound miniprobes facilitates the procedure, as a direct ultrasound scan can be performed down an ordinary endoscope at the chosen site of puncture.
Development and validation of the mirror image comfort and avoidance scale (MICAS)
Published in Disability and Rehabilitation, 2022
Wyona M. Freysteinson, Rebecca Keele, Paul Yeatts, Denika Douglas, Kristin Reeves, Tania Celia, Sandy Crisp, Kimberly Gonzalez, Jinlan Du
Historically, mirror-viewing was considered vain and private with negative connotations [14]. This mirror-viewing instrument provides a unique, innovative, and more positive perspective laying the foundation for a shift in clinical practice from treatment to prevention of psychological disturbances after disfigurement or other trauma. Of significance is that mirror comfort and avoidance are statistically two different concepts, as noted in the literature. Mirror exposure studies of eating and body image disorders have consistently suggested that an individual with body image discomfort may avoid mirrors [28,29].